Psychiatric Diagnoses: Labels, Not Explanations

On March 16, Ronald Pies, MD, published an article in the Psychiatric Times. The article is titled The War on Psychiatric Diagnosis, and the sub-title synopsis on the pdf version reads: “A recent report that argues against descriptive diagnosis in medicine is historically ill-informed and medically naive, in the opinion of this psychiatrist.”

Dr. Pies is a very prestigious and eminent psychiatrist. He is a professor of psychiatry at both Syracuse and Tufts. He was the first editor of Psychiatric Times, which, by its own account, provides “News, Special Reports, and clinical content related to psychiatry” for “… psychiatrists and allied mental health professionals who treat mental disorders … Circulation of the monthly print publication is approximately 40,000.”

The report that Dr. Pies considers “historically ill-informed and medically naïve,” is the BPS November 2014 paper Understanding Psychosis and Schizophrenia, which has been widely discussed in recent weeks.

. . . . .

There is much in Dr. Pies’ paper that warrants critical examination, but I would like to focus here on just one topic: the explanatory value of diagnoses.

Dr. Pies himself acknowledges the centrality of this matter, and writes:

“But there is a larger issue raised in the BPS report that goes to the very heart of psychiatric diagnosis, which the report tries to discredit with the following argument:

We normally expect medical diagnoses to tell us something about what has caused a certain problem, what the person can expect in future (‘prognosis’) and what is likely to help. However, this is not the case with mental health ‘diagnoses,’ which rather than being explanations are just ways of categorizing experiences based on what people tell clinicians. . . . For example, someone who says that they are hearing voices might be given a diagnosis of schizophrenia. Since this says nothing about cause, it makes little sense to say that the person hears the voices ‘because of ‘ the schizophrenia.

Actually, it makes a good deal of sense, in precisely the same way it makes sense to say, ‘Mr Jones has severe facial pain because he has tic douloureux;’ or ‘Smith has severe left-sided head pain and nausea because he has migraines.’ We still do not know the precise causes of these conditions; moreover, the diagnosis of tic douloureux (literally, ‘painful tic’) or migraine headache (etymologically, headache ‘in half the cranium’) is made almost entirely on the basis of ‘what people tell clinicians’ — not on the basis of an abnormal laboratory value, x-ray film, or anatomical finding. (Of course, certain tests, such as a CT scan of the head, can help rule out other diagnostic possibilities, such as a brain tumor.)”

The essence of Dr. Pies’ contention here is that psychiatric diagnoses are just as valid as diagnoses in general medicine, and that, in particular, the absence of knowledge concerning causes does not diminish their status or usefulness.

It has long been my contention that psychiatric “diagnoses” have no explanatory value, and in fact constitute nothing more than vague, unreliable re-labeling of the presenting problems.

This is clearly demonstrated in the hypothetical conversation:

Client’s parent: Why is my son so paranoid? Why does he just sit in his room all day? Why won’t he do anything?

Psychiatrist: Because he has an illness called schizophrenia.

Parent: How do you know he has this illness?

Psychiatrist: Because he is so paranoid, sits in his room all day, and won’t do anything.

The only evidence, and I stress the only evidence, for the so-called illness is the very behavior that it purports to explain. The psychiatric explanation essentially comes down to: he is paranoid, sits in his room all day, and won’t do anything, because he’s paranoid, sits in his room all day, and won’t do anything. There is nothing more to it than that.

I realize that I’ve labored this matter to the point of tedium. But I’ve done so for two reasons. Firstly, because it is one of the core flaws in psychiatry. Its diagnoses have no explanatory value. They are nothing more than labels. Secondly, because psychiatry consistently fails to respond to this particular criticism, and with equal consistency presents these labels as if they did have explanatory value.

The present article by Dr. Pies is a perfect example of the second point, because although Dr. Pies appears to address the issue, he actually side-steps it.

Let’s go back to the quote from the BPS article.

We normally expect medical diagnoses to tell us something about what has caused a certain problem…

This is absolutely accurate. When a person consults a physician concerning a medical problem or concern, there is a general expectation that the diagnosis, if forthcoming, will provide an explanation of the problem. And in practice, this is normally the case. If a person reports exhaustion, pulmonary congestion, elevated temperature, pain in the chest, and nasty-looking phlegm, his diagnosis might be pneumonia. Pneumonia is a viral or bacterial infection of the lung tissue.

What is noteworthy here, in the present context, is that we have two distinct elements: the symptoms and the cause of the symptoms. The person consults a physician because of the symptoms, and, from the physician, he learns the cause of these symptoms. This is what diagnosis means: determining the cause and nature of a pathological condition. Wikipedia gives the following definition:

“Medical diagnosis…is the process of determining which disease or condition explains a person’s symptoms and signs.” [Emphasis added]

Another critical factor in this issue is that there has to be a clear logical link between the symptoms and the diagnosis. If, for instance, the physician’s diagnosis in the above scenario were “incorrect curvature of the spine”, there would, I suggest, be an enormous burden of proof as to how this particular pathology could cause these particular symptoms. But with a diagnosis of pneumonia, the logical link is clear: the infection causes exudation of blood and other fluid into the lung tissue; the immune system triggers an increase in temperature, etc..

So let’s see how our consultation conversation might run in this case.

Patient: Why am I so tired; why did my temperature spike; why am I spitting up such dreadful-looking phlegm?

Physician: Because you have pneumonia.

Patient: How do you know I have pneumonia?

Physician: Because I can hear characteristic sounds through the stethoscope; your chest X-ray shows large quantities of fluid in both lungs; your sputum labs are positive for pneumococcus; and because everything you have told me is consistent with this diagnosis. I can show you the X-rays if you like.

The difference between this kind of conversation and the psychiatric conversation is obvious. In the pneumonia case, the physician has progressed from the symptoms to the essential underlying nature of the illness. In psychiatry, no such progress has occurred or can occur. In psychiatry, the so-called symptoms are the essence of the problem. There is no underlying reality to which the symptoms point. The “symptoms” and the “illness” are identical.

Back to the BPS quote:

“For example, someone who says that they are hearing voices might be given a diagnosis of schizophrenia. Since this says nothing about cause, it makes little sense to say that the person hears the voices ‘because of ‘ the schizophrenia.”

Again, this is accurate. “Schizophrenia” is a label, not an underlying explanatory entity that enables us to understand the symptoms. The phrase “…because he has schizophrenia” is a form of words that looks like an explanation, but in fact isn’t.

To illustrate this, let’s consider another example. Imagine a small child running tearfully to his mother with the complaint that another child has been hitting him. Mother gathers the victim to her arms and soothes him.

Mother: It’s OK. I’ve got you. It’s OK. etc.

Child: Why does he keep hitting me?

Mother: Because he’s a bully. Don’t mind him.

The phrase “because he’s bully” looks like an explanation, and will be accepted by the child as an explanation, but in fact it has no explanatory value. All we have to do to see this is ask the question: “How do you know he’s a bully?”, and the only possible answer is “because he keeps hitting you”.

The statement “he beats you because he is a bully” is logically equivalent to the statement: “He beats you because he beats you.” It contains no explanatory insights into the aggressor’s action. And psychiatric explanations are exactly of this kind.

Now, please don’t misunderstand me. This is not a logical critique of mothers who try to comfort their children. As parents, we do what we can to comfort our children, and there is no great onus with regards to logic or science. But psychiatric concepts and assertions do need to pass the tests of logic and science.

The statement: “Your son hears voices because he has schizophrenia” is logically equivalent to “Your son hears voices because he hears voices.” Schizophrenia is nothing more than the label that psychiatry gives to that loose cluster of vaguely defined thoughts, feelings, and/or behaviors that are listed on page 99 of DSM-5. These are:

The simple fact of the matter is that the reasons underlying these thoughts, feelings, and behaviors are as varied as the individuals who experience them. But psychiatrists make no attempt to explore these reasons. Instead, they rely on the medical-sounding, but facile, “because-he-has-schizophrenia” form of words. As in so many areas, psychiatry has become intoxicated by its own rhetoric, and individual practitioners seem to believe that this form of words actually has some explanatory value.

Back to Dr. Pies:

“Actually, it makes a good deal of sense, in precisely the same way it makes sense to say, ‘Mr Jones has severe facial pain because he has tic douloureux;’ or ‘Smith has severe left-sided head pain and nausea because he has migraines.’ We still do not know the precise causes of these conditions; moreover, the diagnosis of tic douloureux (literally, ‘painful tic’) or migraine headache (etymologically, headache ‘in half the cranium’) is made almost entirely on the basis of ‘what people tell clinicians’—not on the basis of an abnormal laboratory value, x-ray film, or anatomical finding.”

So there is a fairly profound disagreement. The BPS say that the explanation “because he has schizophrenia” makes little sense. Dr. Pies says it makes a good deal of sense. Let’s take a closer look. First, let’s go back to the BPS statement which Dr. Pies quoted and which I reproduced above. Although there are no quotation marks around this passage, it is actually a verbatim quote from the BPS paper, but a crucial piece of the quote has been omitted. (The omission is indicated by an ellipsis in the regular online version, but there is no ellipsis in the pdf version.)

The omitted passage is:

“The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) explicitly states that its categories say nothing about cause – in its own words it is ‘neutral with respect to theories of aetiology’.”

So a summary of the BPS passage might look something like this:

medical diagnoses give us the cause or explanation of a problem

psychiatric diagnoses, by contrast, do not give causes or explanations

psychiatric diagnoses are just ways of categorizing clients’ reports

the APA acknowledges that its diagnoses say nothing about cause

therefore the label schizophrenia has no explanatory value

so, to say that a person hears voices because he has schizophrenia makes little sense

What Dr. Pies has omitted is item 4 arguably the most important part of the passage. So Dr. Pies is accusing the BPS of leaping from

psychiatric diagnoses are just ways of categorizing clients’ reports

to

therefore the label schizophrenia has no explanatory value

and ignores the interim premise which is crucial to the issue. Dr. Pies then uses this distortion to make the point that some diagnoses in general medicine are based entirely on patient report but are nevertheless considered valid and useful. This, of course, is non-contentious. There are, indeed, genuine medical conditions which are diagnosed largely on the basis of patient report. Dr. Pies mentions tic douloureux as an example, and states that the precise cause of this illness is unknown. But he is, I suggest, being less than candid, because a great deal is known, and has been known for decades, about the cause of tic douloureux, which, incidentally, is now usually called trigeminal neuralgia. Here’s the entry for this illness in the 1963 edition of Taber’s Cyclopedic Medical Dictionary:

“Degeneration of or pressure on the trigeminal nerve, resulting in neuralgia of that nerve…The pain is excruciating. Usually occurs after forty. Pain is paroxysmal, radiating from angle of the jaw along one of the involved branches. If the first branch, a shocklike pain is felt along the eye and back over the forehead. If it is the middle fiber, the upper lip, nose, and cheek under the eye are affected. If it is the third branch, pain is in the lower lip and outer border of tongue on affected side. Pain is momentary but returns again and again.” (p T-30)

More up-to-date information is provided by drugs.com, a service of Harvard Health Publications:

“In some cases, the cause of trigeminal neuralgia is unknown. In many people, however, something seems to be irritating the trigeminal nerve, usually in the area of the nerve’s origin deep within the skull. In most cases, the irritation is believed to be caused by an abnormal blood vessel pressing on the nerve. Less often, the nerve is being irritated by a tumor in the brain or nerves. Sometimes, the problem is related to a rare type of stroke. In addition, up to 8% of patients who have multiple sclerosis (MS) eventually develop trigeminal neuralgia as a result of MS-related nerve damage.”

So, if a patient were to ask his physician why he is experiencing excruciating stabbing pains in his face, the response “because you have tic douloureux” is a perfectly logical explanation. It might, or might not, be correct – that is not the issue. But it is a coherent, valid explanation, and is not simply a relabeling of the presenting problems, which is the essential status of all psychiatric diagnoses, other than those specified as being “due to a general medical condition”.

What’s particularly interesting here is that the BPS document is in fact very clear on this matter. The sentence following the passage quoted by Dr. Pies reads:

“An analogy with physical medicine might be a label such as ‘idiopathic pain’, which merely means that a person is reporting pain, but a cause of that pain cannot be identified.”

Idiopathic means “of unknown cause, as a disease.” (Random House Webster’s College Dictionary, 1992). So if a patient were to ask a physician why he was experiencing severe facial pain, the response “because you have idiopathic pain” would simply be a restatement of the presenting problem, and would have no explanatory value. The point being made in the BPS report is that a relabeling of the presenting problem that entails no understanding of cause has no explanatory value. The phrase “because you have schizophrenia” is precisely on a par, logically, with “because you have idiopathic pain.” Dr. Pies’ introduction of, and comparison to, “because you have tic douloureux” is an enormous red herring. His use of the etymological annotation “painful tic” is also a red herring, in that etymology is a poor guide to current meaning. The etymology of the word “mortgage”, for instance, is “death pledge”, because the original meaning of a mortgage was a pledge that a debt would be repaid from one’s estate after one’s death. This is interesting, of course, but has no relevance to the current meaning of the term.

Certainly there are disease entities that general medicine has named, and can identify with reasonable accuracy, prior to establishing the etiology or cause of these illnesses. But this is fundamentally different to the situation that prevails in psychiatry. Firstly, in general medicine there are always prima facie reasons for believing that the condition is an organic pathology. Secondly, the quest of general medicine for explanations and causes has been remarkably successful.

Neither of these conditions exists in psychiatry. In fact, despite an enormous amount of highly motivated research in this area, no psychiatric “illness” has ever been reliably established to be the result of a specific neural pathology. Even Thomas Insel, MD, Director of NIMH, wrote on April 29, 2013:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

Whilst I don’t agree with Dr. Insel in all areas, on this matter he has hit the nail squarely on the head.

The bottom line is this: if one doesn’t know the cause of something, then one can’t explain it. Explanation is the presentation of causes. And despite their frequent claims to the contrary, psychiatrists do not know the cause of the loose collection of thoughts, feelings, and/or behaviors that they call schizophrenia. They assume that any decade now they will discover this cause in the form of some neural pathology. Meanwhile, they go on telling their clients the falsehood that they have chemical imbalances, or neural circuitry anomalies or whatever is the latest fashion, and that these putative illnesses can be corrected by drugs or electric shocks to the brain. And they ignore the reality: that the best (indeed only) way to understand people is to talk to them patiently, compassionately, and with humility, and without the assumption that one already knows the source of their troubles. It is only in this way that we discover that people’s so-called symptoms are understandable within the context of each person’s unique history and current circumstances, and that the facile labels cataloged so conveniently by the APA are an irrelevant travesty.

And, indeed, Dr. Pies himself, even though he clings tenaciously to the need for psychiatric “diagnoses”, acknowledges the additional need to take the time to get to know clients:

“Finally, while diagnosis is a necessary first step in helping the patient with emotional, cognitive, or behavioral problems, it is far from sufficient. We must enter empathically into the patient’s ‘inner world,’ and provide a safe, trustworthy environment for the exploration of the patient’s troubles. This takes time—it can’t be done in 15 minutes!—and it requires what psychoanalyst Theodor Reik eloquently called, ‘listening with the third ear.’ “

But what Dr. Pies neglects to add is that the 15-minute med check has become standard practice in psychiatric care. Douglas Mossman, MD, Professor of Psychiatry at the University of Cincinnati, has written unambiguously:

“Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”

Glen Gabbard, MD, a widely published professor of psychiatry at Baylor and Syracuse, has written on Psychiatric Times:

“There can be little doubt in our current era that the brief ‘med check’ is becoming standard practice in psychiatry.”

“Unfortunately, many prescriptions for psychotropics are written in haste—often after the infamous ’15-minute med check’ – and without any real understanding of the patient’s inner life or psychopathology.”

Dr. Pies, incidentally, also failed to mention that Theodor Reik (1888-1969) was a psychologist, not a psychiatrist, and in fact, had to fight a lawsuit against the medical community in order to establish the principle that psychoanalysis could be practiced by non-physicians.

Nor does Dr. Pies seem to recognize that psychiatry’s contention, that the DSM entities are bona fide illnesses, is, in fact, the primary driving force behind the cursory treatment which he decries so ardently. After all, if people’s problems are caused by brain malfunctions, and if psychiatric drugs correct these malfunctions, what need is there for dialogue or understanding?

There is no factual or logical evidence that the loose collection of vaguely defined thoughts, feelings, and/or behaviors that psychiatrists call schizophrenia is a coherent entity, much less an illness. Nevertheless, psychiatrists continue, not only to make this groundless assertion, but also to prescribe neurotoxic chemicals to “treat” this pseudo-illness, often against the vehemently expressed wishes of the victims. This is not the practice of medicine. It is a travesty which no amount of Dr. Pies’ sophistry can mitigate.

. . . . .

With regards to the title of his piece – The War on Psychiatric Diagnosis – Dr. Pies has this to say:

“If ‘war’ seems a somewhat overheated term in the title of this piece, I would recommend perusal of some of the anti-psychiatry Web sites, on which the ritual evisceration of psychiatry and psychiatrists is unapologetic and unrelenting.*”

The asterisk refers to a footnote:

“*In my view, the Web site of ‘Mad in America’ is particularly abusive toward psychiatrists, though it is far from the worst of the bunch”

Well, of course, there’s anger and vitriol on both sides of this issue, though I must say that MIA has always struck me as the epitome of civility and restraint. But it’s important in this, as in any human endeavor, to rise above the rhetoric, and deal honestly and squarely with the issues. And the issue on the table here is that psychiatric diagnoses – other than those clearly identified as “due to a general medical condition” – have no explanatory value, but are routinely and deceptively presented by psychiatrists as if they did.

And, Dr. Pies has not addressed that issue.

Psychiatry is under criticism because its concepts are spurious, and its treatments are destructive. The problems that psychiatry guards tenaciously as its turf are not medical in nature, but for the sake of that turf, are shoe-horned shamelessly into psychiatry’s bogus nomenclature, and are “treated” with neurotoxic drugs and electric shocks to the brain. Petulant complaining about the “ritual evisceration of psychiatry and psychiatrists”, is no substitute for rational, honest, and informed debate.

Behaviorism and Mental Health: Philip Hickey is a retired psychologist. He has worked in prisons (UK and US), addiction units, community mental health centers, nursing homes, and in private practice. He and his wife, Nancy, live in Colorado, and have four grown children. His posts can also be seen on his website, Behaviorism and Mental Health.

Had this happen only way back, but it still helped none of them moisten a finger to turn to the right page in their Bible for helping me explain myself about traumatic situations I expected to have brought me to them. They see and they don’t see and won’t make up for their dumbest stuff.

Lets consider the influence role of big pharma in the scenario listed above:

Client’s parent: Why is my son so paranoid? Why does he just sit in his room all day? Why won’t he do anything?Psychiatrist: Because he has an illness called schizophrenia.Parent: How do you know he has this illness?Psychiatrist: Because he is so paranoid, sits in his room all day, and won’t do anything.

The psychiatrist is now in a position to pitch a profitable neuroleptic drug to correct the “chemical imbalance.

Lets consider the above situation with a professional with an intellectual curiosity who does not receive free gifts from big pharma is not influenced by those who do:

Client’s parent: Why is my son so paranoid? Why does he just sit in his room all day? Why won’t he do anything?Psychiatrist: He takes Dexedrine for ADHD and this can cause paranoia and possible psychosis. Could he possible now be using methamphetamine?Parent: He has been taking dexedrine for the last few years without a problem He is so secretivePsychiatrist: Drugs like this cause a hyper focus and his drug induced paranoia will make him very discreet……

You hit the nail on the head. What I don’t understand , is that if a lot of people know that psychiatrists label people for profit, then why do they allow it? I am going to share something with you, I sent a FOIA request NIMH to find out if the “chemical imbalance” theory was actually true.

NIMH FOIA Data Reveals that FDA Should Stop False Chemical Brain Imbalance Advertising
NEW JERSEY –With the age of retirement upon me, and the new freedom I have to fulfill a dream of a freelance investigative reporter, I find I am very much interested in the advancements and new developments concerning the human body. One thing in particular I found while researching on my computer from my New Jersey home, was a statement in the July 11th edition of “Psychiatric Times” [the official publication of the American Psychiatric Association (APA)]by APA Director Ronald Pies, about how the chemical imbalance of the brain theory of mental illness is “…urban legend – never a theory seriously propounded by well-informed psychiatrists.” The statement dumbfounded me as every advertisement on psychiatric drugs I have ever seen promotes that their drugs work by correcting a chemical imbalance and because the FDA is required to stop fraudulent advertising of drugs.
With that thought in mind, I decided to do a Freedom of Information Act (FOIA) request to the highest authority I knew, the United States Substance Abuse and Mental Health Services Administration (SAMHSA) for any evidence they had on file showing :
“1. That a chemical imbalance of the brain causes mental illness;
2. What a proper balance of brain chemicals and/or neurotransmitter levels would be; and
3. What neurotransmitter levels such as in serotonin or dopamine would cause a person to have different biological mental illnesses such as depression, bi-polar disorder, attention deficit hyperactivity disorder and schizophrenia.”
I thought that they would send me a quick answer to what must be a very common question but instead of answering it, SAMHSA referred my FOIA request to the National Institute of Mental Health (NIMH).
I found it exciting and unusual that this major societal answer to such an important question about life, from the world’s two highest mental health authorities, would soon be delivered to a retired grandmother in New Jersey . It is this promotion of chemical imbalance and neurotransmitter-correcting drugs that is why people take them, why the drugs are supposed to work at all and why people, including children, the elderly in nursing homes, mentally disturbed persons, prisoners and many other individuals are ordered by judges and other authorities that they must take them. The advertising is so prevalent that the chemical imbalance theory has become pop culture. But, is it true?
NIMH’s FOIA department sent my questions to the NIMH public relations people who sent me an answer, sort of. Their December 16, 2014 answer gave me a link to PubMed which basically contains most all medical studies on all subjects from all time periods, along with links to various blogs on the subject by NIMH Director Tom Insel. There was no direct answer except for direction on where to research.
I decided that the PubMed link would be too far-reaching to be considered an answer to my questions so I started researching the data by Director Insel as the official NIMH/SAMHSA answers on the subject. There was a lot of information, mostly written in medical terminology and on related subjects such as the psychiatric diagnostic manual, the ineffectiveness of psychiatric drugs and how “they do not work on most people.”
You can follow this line of research that I was given with research to the NIMH website, Dr. Thomas Insel’s blogs on antidepressants and schizophrenia treatment, his article and this web page, http://www.nimh.nih.gov/about/director/index.shtml by Insel and his blogpost. The only reason that I am giving you all these different data sources in such a disjointed manner is that it is how I received them from NIMH instead of simply getting an official answer.
As I went through all this data, I realized that NIMH’s stance was that their research from improved neuroimaging equipment showed that different types of behavior, like anxiety or depression, seemed to come from different sections of the brain, as opposed to the current neurotransmitter theories and that with more answers, maybe 20-30 years in the future, we may find the sources of mental illness so that cures can be created.
On January 16th, 2015, after doing this research of the links that NIMH sent me, I asked NIMH to confirm, in layman terms, my new understanding of NIMH’s view on the cause of mental illness which was:

“Mental health scientists previously believed that the mental illnesses of depression and schizophrenia were caused by a chemical imbalance of the brain that was caused by an overall lack of serotonin or increase in dopamine. Great advances in neuroimaging that has now allowed us to see much more deeply into the brain shows that these and other mental illnesses are connected to deeper disorders within the neural systems of various parts of the brain and not by an altered amount of neurotransmitters which makes us closer to fully understanding the diseases and to finding mental illness cures.”
Instead of getting a simple confirmation or slight alteration in message with a little public relations spin from NIMH as I expected, I was referred to two more links January 27th to further research which were http://chronicle.com/article/A-Revolution-in-Mental-Health/141379 and a video http://www.nimh.nih.gov/news/media/2013/introduction-to-rdoc.shtml#transcript_section
Since I realized that NIMH’s public relations department was seemingly fearful of even telling a New Jersey grandmother that the mental health emperor has no clothes regarding real science behind the reason for mental illness or how drugs work, I decided to research further into these two links and they were very revealing. If you check yourself, you will find that NIMH sees many possibilities for the different mental disorders and that they certainly do not come from neurotransmitter levels such as too much dopamine or too little serotonin as we constantly and fraudulently see advertised.
So, Food and Drug Administration, please do your job by banning these fraudulent and misleading psychiatric drug ads that have a large percentage of our population hooked on drugs. When researching several psychiatric drug ads, they all generally stated that although they don’t know exactly how their drugs work, experts believe that they are correcting a chemical imbalance of the brain and neurotransmitter levels that cause mental illness. That is obviously misleading as our highest official mental health authority, National Institute of Mental Health, is giving other reasons for mental illness and also states that these mental health drugs do not help most people and never cure anyone. US citizens are counting on the FDA to be truthful with those of us, who have put their trust in them for so long, to protect us from fraudulent marketing and unworkable drugs. The FDA certainly should not be complicit in covering up the truth.
If any government official or media representative would like the exact email exchange of documents with SAMHSA and NIMH, feel free to email me at [email protected].

Thank you for this great article and your community service; psychiatry is counterproductive to mental health. Psychiatry is destructive because it advocates that mental distress is a medical problem rather than a social problem. Mental distress is natural emotional suffering- emotional distress from distressful experiences. The erroneous concept of “mental disorders” is based on the logical deduction that the generally painful irrationality of mental distress is a disorder of a “normal” mental process. Natural Psychology explains this paradox; please consider Natural Psychology- the real science of mental distress. It is published online at NaturalPsychology.org; I would appreciate any feedback.

I wholeheartedly agree, and thank you as always, for speaking the truth, Dr. Hickey. Understanding the etiology of my symptoms was very important to me. And I did not find being psychiatrically stigmatized as “bipolar,” “paranoid schizophrenic,” “depression caused by self,” “schizoaffective,” and finally “adjustment disorder” to be remotely helpful, just defamatory – and defamation of character is, by the way, illegal in the US.

I was unable to find any doctor who would medically explain the etiology of my symptoms, due to the White Wall of Silence. But, thankfully, I was able to find the medical explanation of my symptoms on my own. And my last two doctors have agreed with my medical research.

I suffered from the common symptoms of antidepressant discontinuation syndrome due to being inappropriately abruptly taken off of a non-“safe smoking cessation med.” “Antidepressant discontinuation syndrome is a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs, including selective serotonin re-uptake inhibitors (SSRIs) or Serotonin–norepinephrine reuptake inhibitors (SNRIs). The symptoms can include flu-like symptoms and disturbances in sleep, senses, movement, mood, and thinking. In most cases symptoms are mild, short-lived, and resolve without treatment.”

These symptoms instead were misdiagnosed, according to the DSM-IV-TR, by three different doctors as “bipolar,” “paranoid schizophrenia,” and “depression caused by self.” The PCP who claimed I was a “paranoid schizophrenic,” unbeknownst to me at the time, was paranoid of a possible malpractice suit because her husband had been the “attending physician” at a “bad fix” on a broken bone of mine. The psychologist who claimed “depression caused by self” actually wrote in her medical records that her diagnosis was based on the fact that, “Pat didn’t like her.” My child had been sexually assaulted at Pat’s house, and adamantly refused to get into Pat’s car in front of a bunch of teachers.

“The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity.” I’m quite certain the DSM diagnoses are neither reliable, nor valid.

The misdiagnoses of antidepressant discontinuation syndrome were then treated with a child’s dose of Risperdal, .5 mg. Within two weeks, this resulted in psychosis caused by the central symptoms of neuroleptic induced anticholinergic intoxication syndrome. According to drugs.com: “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

But my doctors all claimed this medically confessed “Foul up” with Risperdal was the “life long incurable genetic” “bipolar disorder.” One has to wonder how often the central symptoms of neuroleptic induced anticholinergic intoxication syndrome are wrongly claimed to be “bipolar” or “schizophrenia,” since the symptoms are almost exactly the same as the symptoms of schizophrenia. And a grown adult can be made psychotic within two weeks of being put on a child’s dose of Risperdal.

When a patient is “hyper” about finding out the actual etiology of their symptoms, she will indeed figure it out. And I hope some day the psychiatric industry will get out of the business of covering up child abuse and easily recognized iatrogenesis via their psychiatric stigmatization and poisoning of innocent patients.

Thanks for this. I think that over the next few years, we will discover that there have been a very large number of people “diagnosed” with serious “mental illnesses” who were in fact experiencing withdrawal from psychiatric drugs. There is a general reluctance on the part of psychiatry to acknowledge that their “treatments” can actually cause damage.

Phil, this was a good article. Your point was carefully articulated and as usual, the psychiatric emperor is revealed to have rather few clothes 🙂

Unfortunately, we cannot and should not expect that psychiatrists in a position like Dr. Pies will be willing, or even able, to think logically about the issue of diagnosis. To think logically and clearly about psychiatric diagnosis would constitute a direct threat to Dr. Pies’ identity as a medical doctor, would undermine his status as an “expert” in his profession, and might ultimately threaten the ability of psychiatrists to earn large amounts of money via brief appointments and excessive use of psychotropic drugs.

So it makes sense that he is unable to think logically about this issue; however, the reason has little to do with the argument at hand. Of course he is threatened by sites like Mad In America; it’s disturbing when people see right through you in a way that threatens your professional livelihood and supposed status as an expert.

I want to touch on an entirely different issue that I thought of while reading your article. I would suggest that these type of arguments could be correctly made over and over, but little may change for people given the label schizophrenic, at least in America. In my opinion, it might be more useful if there were stronger evidence that severely troubled people – people often labeled “schizophrenic” who in reality experience unique combinations of delusions, hallucinations, withdrawal, etc. – could be helped by intensive, prolonged human help.

Unfortunately, authors like John Gunderson and Thomas McGlashan were able to create the illusion that psychotherapy (i.e. human help and understanding) is of little help to “schizophrenics” – again, people exhibiting random varieties of psychotic symptoms. They did this by having inexperienced hospital residents provide short-term psychotherapy to hospitalized patients, and then comparing these results to use of medication. This created the illusion that “psychotherapy” was a construct that could be compared with medication as if one was comparing Zoloft and Prozac. But of course, the training of the therapist, length and frequency of psychotherapy, etc. matter immensely, and every psychotherapy is different.

Some studies have indicated that a certain intensity and length of human help was much more effective than medication alone for very troubled people, people often given the unfortunate label “schizophrenic”. A few of them would be – Bert Karon’s study comparing 70 sessions of psychotherapy to medication only, in his book Psychotherapy of Schizophrenia: The Treatment of Choice, The Open Dialogue treatments people experiencing psychotic breaks, reported by Jaakko Seikkula; Bent Rosenbaum’s Danish trial comparing the effect of 1 year of weekly psychodynamic psychotherapy to medication alone in over 200 people with “schizophrenia”, Gaetano Benedetti’s study of 50 psychotic patients treated in psychodynamic therapy three times a week for five years, reported in his book also titled Psychotherapy of Schizophrenia, and Colin Ross’ study of about 50 “schizohrenic” patients given two years of twice-weekly psychodynamic psychotherapy, from his book Schizophrenia: Innovations in Diagnosis and Treatment.

These studies will always suffer from the problem that “schizophrenia” lacks reliability/validity, and that psychotherapy cannot be truly operationalized. But, they can at least indicate trends about what may be more helpful for severely disturbed people. The studies listed above provide strong indications that long-term human help, with or without medication, is WAY more helpful than medication alone for people experiencing whatever combinations of psychotic symptoms. But there are still far too few of these studies.

My point is that it would be useful if more evidence could be produced showing what is intuitively obvious – that prolonged human help with or without medication is much better than medication alone for people experiencing different varieties of psychosis. This would build a hopeful weapon with which to fight psychiatry’s medication focused, hopelessness-inducing attitude toward people experiencing “psychosis” – perhaps a better weapon than simply refuting psychiatrists’ arguments, however correct such refutations may be.

An important question is how to provide funding and incentive for research focusing on providing long-term human help in addition to just medication. That is going to be a challenge, given the incentives driving many psychiatrists to manage people with medications and short-term appointments, rather than understand and help them in a long-term intensive way.

Thanks for this. You’ve hit so many nails on the head. In the 60’s and 70’s, there was actually a good deal of this kind of research being done in hospitals and other settings. See Chapter 18 “The Sociopsychological Formulation and Treatment of Schizophrenia” in Ullmann and Krasner A Psychological Approach to Abnormal Behavior (1975) for a good introduction to this field. My own view is that this kind of endeavor was suppressed precisely because it was being so successful. It had become a significant threat to psychiatry’s hegemony, especially as the drugs began to come on stream. You are correct, of course, that we need to see a return to this approach, but unfortunately, psychiatry, fighting, as you say, for its very existence, will resist vigorously.

I was heartened by Dr. Pies’ complaint about Mad In America. It shows that mainstream psychiatry feels very threatened by any real public discussion of its shortcomings.

What will he be saying if/when our movement for human rights actually leaves its bubble and starts fighting back very publicly?

I think mainstream psychiatry feels so threatened is because they know the profession is based on lies and does a lot more harm than good. Once the media starts giving some space to our arguments, psychiatry is going to be very exposed. And I think that will happen.

A psychiatrist who can’t admit that people have been hurt by psychiatrists and drugs and allow people who have been to express their feelings about it needs to get real, and grow up. I’m not getting paid to deal with his/her personal problems.

Ted-
I don’t know how you came back from what you survived, and understand my having to read your book directly, in order to further understand myself and recovery, although going through much less total abuse in my life.

I was heartened by Dr. Pies’ complaint about Mad In America. It shows that mainstream psychiatry feels very threatened by any real public discussion of its shortcomings.

I don’t mean to be negative but I can’t help feeling that this corruption is all linked. The corruption in psychiatry isn’t isolated.

We have mandatory vaccines getting pushed… strange oppressive censorship “diversity”, feminism… hell it looks like even riots are being funded ? whole mass shootings or bombing might even be completely made up ?

I really hope there’s some good guys out there that have some idea how to clean all this dodgy behavior up because the world to me looks like it’s in a lot of trouble and the falsehood of psychiatry is just one part of the greater disease.

I couldn’t agree with you more. Don’t you think that psychiatrists would have a sort of “cleansing of the soul” if they just admitted their errors and the harm they have caused endless numbers of people?

Also, I hope that as you have stated that “Once the media starts giving some space to our arguments, psychiatry is going to be very exposed.” , does happen. However , what can we do to hasten this along? Who actually has the biggest hold on that profession as to make this happen. I know the power lines go very far up, but WHO needs to be brought down so that people get their lives back?

“Other recent research indicates that criteria for IED best identifies a group of individuals with robust differences in clinical characteristics, neurobiological findings, and documented responsiveness to treatment. In addition, other data strongly suggest important delimitation from other disorders previously thought to obscure the diagnostic uniqueness of IED.”

Seriously?

I also love how they define aggression by injury to self. Now if you want to hurt yourself you’re aggressive just as much as if you wanted to punch someone else. I guess I don’t have to tell anyone where this is going.

I guess that would make a lifetime prevalence of IED approximately 100%. I don’t know how they get to <10%, maybe because they didn't decide which anti-explosion drugs to promote.

"There has been evidence for the association between impulsive aggression, and/or irritability, and cardiovascular morbidity for many years. (…) Specifically, the study noted that in individuals with IED, there is an increased risk of coronary heart disease; hypertension; stroke; diabetes; arthritis; ulcer; headaches; and back/neck pain and other chronic pain. Another study reports a significant correlation between IED and diabetes."

…and if we don't "treat" you you're going to DIE. Btw, irritability in diabetes is a normal symptom and is treated with adjusting blood sugar with insulin or candy depending which way it goes. Not by psychiatrist. They are not satisfied with turning every aspect of normal human behaviour into illness – now they come for real illnesses to be turned into fake psychiatric ones depriving people of real medicine.

I'm not even starting to comment on the rest of the article and their musing about serotonin and drugs treatments because I seriously get severe IED symptoms reading this crap. Truly – DSM = the great book of insults.

I simply don’t understand how so many people can believe that “mental disorders” are so prevalent AND genetically based. By that logic, it’s just a matter of time before the entire human race is too damaged to function.

In the psychiatric facilities I’ve been in, I’ve met lots of people who’ve claimed to be “schizophrenic”, but nobody that has looked too abnormal to me (in comparison to average). My impression from the start was that psychiatry was a ‘pretend medicine’; the “schizophrenia” being there for the doctors benefit.

The problems I had at the beginning of my psychiatric life, were a lot worse at the end of it. But I was able to find good solutions for these problems through the normal psychological process (to make full recovery).

I got a great deal of help from therapy, then it went bio-bio-bio and I got a lot of harm. I’m almost over it now, I think; but the fact that the marketing of the disease and medicate model has been so successful and is believed in so absolutely, I still have to keep pushing back.

And, of course, spending time with others who are doing the same is a fine ingredient for recovery. Psychiatry can make you feel so crazy, ya’ know.

I think it’s wrong to blame psychiatrists and other professionals for their pattern of explaining behaviors as being caused by the label they make up for that behavior. They can’t help it: this is clearly a symptom of “Circular Reasoning Disorder” and that’s why they do it. I’m not sure what the treatment should be, but maybe if we talked to the drug companies they could find something for it?

Yes, I recommend 200mg. Thorazine 4 times a day with 5 mg halidol and 12 mg of stelazine as a kicker and a rest in a reclining beach lounger for 4 hours per day starting at high noon to take in some sunshine___I’m not a psychopath either or I wasn’t until they made me one. No justice No peace .

Dr. Hickey, thank you very much. Prior to any deliberate investigations, when I was twenty-three I understood that since my skull wasn’t getting opened, and the drugs were of the same principles for inducement of altered thought and behaviors as street drugs, that the main thing I would be getting was information through relationship with a doctor. How much worse could being half-right turn out?

Very good question. Psychiatry has created the idea of depression as an incurable illness for which one must take pills for life. Previous generations thought of it as a normal part of life which we navigated using time-honored techniques and with the help of friends, family, etc…

You are correct, of course, in pointing out that some psychiatric textbooks mention psychological and social issues as contributory factors, but then they immediately neutralize this contention by calling these problems illnesses

It wasn’t an intentional misquote, besides what I wrote was what you meant. You added the word illness. That’s okay.

One more thing. The psychiatrist I have once asked me “What do you think we do when someone comes in with depression? Sometimes we do nothing! This is because he may have a problem in living rather than a deep depression (in which case drugs are useful). ”

I have written more about him and my experiences on your article about anti-depressant induced mania with which I have plenty of experience.

During acute phases or in cases where a person’s depression (or anxiety) is debilitating and comes back over and over again, drugs are useful to sustain functionality. I take pharmaceutical drugs everyday. In general, barring the side effects, they help me function better.

“…I don’t believe there is a single, veridical definition of the term ‘disease.’ Much depends on the use to which the word is put, and this varies considerably among epidemiologists, pathologists, and, yes– psychiatrists!”

But in a paper that he wrote on April 18, 2013, he stated:

“So long as the patient is experiencing a substantial or enduring state of suffering and incapacity, the patient has disease (dis-ease).

This sounds very much like a definition, and if the word “and” were amended to “or” would be virtually identical to the APA’s definition of a “mental disorder”: distress or impairment. Meanwhile, the common usage of the word disease is something going wrong with the structure or function of the organism, and in my view, this is the intended meaning of psychiatrists who say things like: depression is a disease caused by a chemical imbalance in the brain; schizophrenia is a disease caused by a chemical imbalance in the brain; etc…

David – I suppose many people have and can get hold of this book. Online is this one which has the same types of info, more basically and not so pointedly argued as Levy’s….. But it is great improvement over what my elective in pscyh offered, which also was not the worst thing around for the time… the Keller plan…which went straight into experimental psych and stayed there lots. So this text by Boeree struck me for taking time for the whole of intellectual history and then going through the logical fallacies as means to the ends for psychology. http://www.ebooktrove.com/psychology/history_psychology_i.pdf

I took a glance at your Ashland concern, the Mental Health and Recovery Board, and liked it a lot. Here’s what I think, though: the culture for behavioral healthcare is so screwed up and so devoted to and reliant on arrests and involuntary treatment, saying some people need qualitatively different attention from anything that psychology even understands, that most folks in it here in the U.S. don’t make out the demarcations that set groups like yours off from the standard fare. To me, it’s obvious that in my town the philosophy for community mental health equates with the Hammer Mechanic’s in the Sears Auto Department. The idea reflects in all the available services. So, while it appears polar opposite to what your group suggests, I believe they would think such differences all a wash amidst necessary trade-offs, and that the clinical work getting done is uncontestably close in approximation to what clients truly must need. It’s as though nothing at all is amiss except what Al Frances says…not enough serious attention to these most awful diseases… and We Need Bucks!

Does that mean the robber baron ,government, big pharma psychiatric industrial complex plus , can not more simply be referred to as the Redux SS Physician Josef Mengele Project or Mengele Project II ? Or even, The kinder gentler time released Mengele Project II and Associates ?

Ronald Pies, and the many psychiatrists who think as he seems to think, remind me of the earlier snake oil peddlers that sold people colored water for their ailments. And society then acted just as society does today; swallowing anything that psychiatry and the drug companies say as gospel truth. Pies also reminds me of the carnival guy who posed as a wizard in the city of Oz. Remember what he says when Toto pulls the curtain open? “Pay no attention to the man behind the curtain, I AM THE GREAT AND POWERFUL OZ!

I will continue my attempts to ritually eviscerate uniformed psychiatrists and psychiatry until they admit that what they are and what they do is a total fraud, period.

I have been a long time reader of your blogs and I usually agree with much of your criticisms about psychiatry. I believe that you are correct in saying that many people are over-diagnosed and over-medicated.

However, in the case of people who are severely psychotic I think that you are minimizing the extent of their dysfunction and their pain. You say: “that people’s so-called symptoms are understandable within the context of each person’s unique history and current circumstances.” When my son becomes psychotic his thoughts and behaviors are not understandable within any context whatsoever.

Dr. Pies mentions in his article the recent discoveries in relation to psychosis caused by auto-immune factors and NMDA. The book “Brain on Fire” by Susanna Cahalan tells her story of battling this terrible disease which was first diagnosed in her as schizophrenia. There are many known causes of psychosis and probably many causes which have not yet been discovered. Just because we don’t always know what causes psychosis does not mean that there is not an underlying biological cause. Some psychosis may be explainable by listening to a person’s history of trauma or abuse, but certainly not all. I am grateful to those researchers who continue to look for all the causes of psychosis so that all those suffering may find effective treatments.

Thanks for coming in. I’m sorry to hear about your son. I certainly respect your position, but I don’t agree that the loose collection of vaguely defined thoughts, feelings, and/or behaviors that psychiatry calls schizophrenia is a disease, in any ordinary sense of the term.

And the psychological and social occurrences with which we associate the term can also be seen.

The biggest problem is, people because of their ignorance tend to classify all people with a particular label as similar (as though it were like chicken pox). This is totally wrong.

For instance I have seen people with the schizophrenia label whose behaviors are quite out of touch with reality, they are quite psychotic and irrational. On the other hand I’ve also seen people with the same label who are rational, have postgraduate and even doctoral degrees. The latter kind may have had temporary lapses in sanity at some point in their lives due to whatever reasons (as a result of which they got the label) but are otherwise quite fine (perhaps treatment may have helped or they have other coping mechanisms or someway in which they achieved remission). This applies to all psychiatric labels.

Registered,
I understand what you’re saying but my comments were trying to take the argument back to Phil’s piece. Being able to “see” “real symptoms” is NOT the same as being able to see a virus. Since the predominate view is a medical/disease model of mental illness – Phil’s point is very important. That individuals experience real distress is not in question. What is in question is that psychiatric labels are real in the same way that medical diseases are real. I believe that was the author’s point.